IN MAY 2014, the editor’s note of the publication “What Doctors Don’t Tell You” (WDDTY) told a personal story about stem cell therapy. Editor Lynne McTaggart learned, based on an ultrasound and arthroscopy, that her daughter’s ACL (anterior cruciate ligament in the knee, a frequent victim of sports injuries) was “beyond repair without surgery.” But she also knew that — compared with leaving the injured ACL alone — many who undergo reconstructive surgery continue to have pain, never regain full strength and often require additional surgeries; ten years down the road they have a greater likelihood of developing arthritis.
For years now, embryonic stem cells have been touted as providing exciting possibilities for treating everything from diabetes to neurodegenerative diseases, including Parkinson’s and Alzheimer’s as well as multiple sclerosis. Embryonic stem cells have the potential for developing into different kinds of specialized cells — muscle cells, red blood cells, brain cells — which, because theoretically these new cells can continue to divide without limit, could serve as permanent repair systems for the body.
But embryonic stem cell therapy for most of these conditions remains “pre-clinical” — that is, studies have not yet begun in people. Dr. Doug Melton leads the research team at Harvard that in October, 2014, announced a “giant step toward new diabetes treatment…We are now just one pre-clinical step away from the finish line,” he said. But still years away from treating people.
The only currently approved stem cell therapy is bone marrow transplantation, which has been used for more than 30 years to treat cancer patients with leukemia and lymphoma.
An alternative to embryonic stem cells are adult stem cells — especially self-derived or “autologous” stem cells from the patient’s own body, making it less likely the body will reject them. For treating multiple sclerosis, human trials using self-derived adult stem cells are now underway but enrollment is limited. Some MS sufferers who have traveled abroad for this therapy have reported improvement in symptoms.
Meanwhile, most mainstream orthopedists are cautiously awaiting the results of additional trials. In the interim, treatment for orthopedic problems using self-derived adult stem cells is being offered at centers around the U.S., including at Emory University’s Orthopaedics and Spine Center. Compared to conventional treatments for pain associated with osteoarthritis — physical and occupational therapy, steroids and hyaluronic acid (a substance found in joints) — stem cell therapy is the most exciting, according to Emory University physical and rehabilitative expert Kenneth Mautner. He points out that, while hyaluronic acid can help lubricate joint and sometimes relieve pain, “it does nothing to restore lost tissue.” In Dr. Mautner’s opinion, a stem cell injection is a small gamble when the outcome may postpone major surgery.
At StemCell Arts in Fairfax, Dr. Mayo Friedlis, a specialist in pain management at the National Spine and Pain Centers in Chevy Chase and Fairfax, uses self-derived stem cells to treat rotator cuff problems, tennis elbow, hip arthritis, ankle sprains — “any place that there’s a ligament or tendon injury is amenable to this.”
The StemCell Arts therapy, called Regenexx, uses healthy stem cells extracted from the patient’s own hip bone marrow. These stem cells are mixed into platelet-rich plasma (PRP) — blood from which red and white cells have been removed — which has been shown to spur cell proliferation and cartilage repair.
Dr. Friedlis explains that “those bone marrow cells will turn into cartilage cells, into ligament cells, tendon cells; wherever the area of injury is, the stem cells are smart enough to figure out what they have to create.”
The most recent and most impressive study on adult stem cell therapy for orthopedic problems, led by USC orthopedist Thomas Vangsness, Jr. and colleagues, looked at patients in seven medical institutions. Among those who had partial meniscus (knee cartilage) surgery, 35 received injections of stem cells while a control group of 19 received hyaluronic acid. Among those patients receiving stem cells, there was evidence of meniscus regeneration and “a significant reduction in pain,” compared to those who received the control.
The FDA’s recent ruling that one’s own stem cells should be considered a drug — and subject to the agency’s control — is currently being challenged by a group of Colorado physicians. The American Association of Orthopaedic Surgeons takes the position that “stem-cell procedures in orthopedics are still at an experimental stage… and are performed [only] at research centers as part of controlled, clinical trials.” As a result, most insurance companies will not cover the treatment, which costs between $4,000 and $6,000.
Lynne McTaggart’s daughter received injections of PRP and stem cells into her meniscus, into a damaged tendon, and into the knee capsule, a ligament that encircles the knee. The goal was to strengthen each of these sufficiently to protect the knee without repairing the ACL. At last report, her daughter was doing well and preparing for upcoming sports seasons.